After reviewing the case history, can we accept the final conclusion of Rees and his co‑authors that Hess was just a schizoid psychopath, and no more? This is a diagnosis and like other diagnoses has to be supported by evidence that is weighed up with this and other possibilities in mind; it is only after one has formulated a diagnosis that one can proceed to interpret the psycho­dynamic and other motive factors. We are not given any such evaluation of the evidence. In the account of Hess's life before he flew to Scotland, the principal evidence to support a diagnosis of psychopathy is that he was a political activist, a fanatical Nazi, a teetotaller and nonsmoker, after a fair number of internal disorders somewhat of a hypochondriac, and one who turned more and more to unorthodox practitioners and dieted himself strictly. In this, there is hardly enough evidence to maintain that he was an unstable and psychopathic personality, with hysterical and paranoid reactive symptoms; indeed tendencies to instability, hysteria and personal paranoid reactions do not look very marked. The diagnosis of a hysterical and paranoid reaction is based, in fact, on the psychotic symptoms observed, and not on the past record. But, even having made a diagnosis of psychopathic personality, this does not mean that other possibilities have been excluded. The question of a super­imposed psychotic state should have been considered on its merits. This was not a mode of approach which is likely to arise with a socio‑psychological model of psychiatric illness, in which there is room for every kind of subject­ivity and easy short cut. Much of the reasoning in the Rees book appears to be circular: Hess was an egocentric and psychopathic man, and hence flew to Britain and behaved strangely there; since he flew to Britain and behaved so strangely, he must have been a psychopath.

     Could the opinion that there was no more psychopathology than that of a neurotic reaction, have been based on a misreading of the evidence? Might this have been caused more particularly by the repeated occurrence of a hys­terical amnesia, which certainly loomed large in the minds of the medical corn­missions of the Allied Powers? The amnesic state does indeed seem to have been hysterical, i.e. part of the reaction of an abnormal personality to an ex­ceedingly stressful situation. It does not seem to be attributable to acute exacerbations of the schizophrenic process, since other psychotic symptoms were usually milder when Hess was amnesic. However, it may have been contributed to or facilitated by underlying schizophrenic throught disorder. The amnesic state came and went in an arbitrary way, and was interpreted (as random events always can be, given good will) along psychodynamic lines. This was, of course, a neurotic symptom; and psychiatrists are always tempted to interpret neurotic symptoms as arising from a neurotic background ‑ despite the fact, well known to all of us, that neurotic symptoms in general and hysteri­cal conversion symptoms in particular, can appear in any kind of setting, including affective and schizophrenic psychoses. It is indeed rare for graver illnesses, such as organic brain conditions, not to release some neurotic symp­tomatology. If we think that Hess had a schizophrenic illness, the occurrence of hysterical symptoms is neither here nor there evidentially, and neither tends to support nor to rebut the diagnosis.

     The only well established way of making a reliable diagnosis of schizo­phrenia, i.e. one which can be validated, and will stand up to a check against follow‑up information, is by means of phenomenological analysis, using the systematic methods explored and developed mainly in the German school of psychiatry by such workers as Grühle, Mayer‑Gross, and Kurt Schneider among others. We have in Rees's book a carefully kept and accurate record of Hess's state over the years of his imprisonment in Britain May 1941 to October 1945, and the continuation of the medical record in the Nuremberg gaol till October 1946, that is over five and a half years. During the whole of that time he was never mentally normal, and for long periods he was troubled with grossly psychotic symptoms. His mental state fluctuated in a way that is characteristic of a schizophrenic psychosis, with the interesting feature that when his state of amnesia came on, the delusional and persecutory symptoms regressed.

     Although Hess was an odd personality, with schizothymic traits, there is no suggestion that he had any outright mental illness until his flight to Scotland in May 1941. This act was an insane one. If the idea had been simply one of making contact with the British, it would have been possible, as von Papen said, to get in touch at a moment's notice through a neutral power. Hess's idea, of flying personally, of somehow meeting an unimportant British no­bleman, of being taken to speak to the King, when all would arrange itself and he, Hess, would have brought back peace on earth, this idea has the typical grandiosity of a messianic delusion. The idea seems to have come to him, as a primary delusional experience, when told of the dreams of Professor Haushofer. Paranoid ideas were shown in a letter to Germany written nine days after his landing; and they remained with him throughout the course of the illness, without any period in which one could be sure he was free from them. Endless pains were taken to convince him of the falsity of his beliefs, to reassure him and make him feel safe from his imagined dangers. He remai­ned absolutely impervious to reason; and when, for instance, he had to concede that his doctors and nurses could not possibly be so many murderers, the delusion was saved by interpreting them as under a hypnotic trance and without will of their own.

     In the course of the medical record we are given a glipmse of the sudden appearance of a primary delusion: "I will look at a piece of bread or bit of food and suddenly I feel sure that it has been poisoned." From such origins, the delusions burgeon and spread. They take increasingly bizarre forms: a dictionary rots in his hands; he is poisoned by secretions from pigs' and camels' glands; even the running water is poisoned; his apples are injected with "hot poison." They become more and more universal. Early on he can tell by the glassy stare in their eyes that his doctors, guards and attendants have come under hypnosis; later on there is hardly any notable figure on the wartime world‑scene who has not similarly been put under control by the Jews with their occult powers ‑statesmen, generals, envoys and kings.

    Apart from originating in primary delusional experiences, delusions seem also to have arisen from altered perceptions, both internal and external. He felt the workings of his own viscera not to be normal, and interpreted the abnormalities of function as the result of poison. There were many passivity experiences; sudden feelings of exhaustion and sudden feelings of well‑being (abnormal autonomous mood states) were equally attributed to poison. The experience of time is changed; the world around is changed; the people have glassy eyes.

     He is aware of his own thought disorder; he feels a mental confusion; his mind goes blank. It seems probable that the amnesic states, showing themselves from November 1941 on, are based in part on thought disorder. Thought disorder is shown also in his ways of arguing and his answers beside the point.

     Auditory hallucinations in clear consciousness are repeatedly noted; he turns to look behind him, and stare into the bushes; he suddenly turns his head to a corner of the ceilling and looks intently "as if straining to identify some sound." He lies with his fingers in his ears, smiling to himself.

     There are sudden and violent surges of abnormal affect, as is shown in both his suicidal attempts, especially the first. But bit by bit affectively he goes on to a totally autistic state, so that at his trial he is cut off from rapport with anyone, his guards, his doctors, his own colleagues, his counsel.

     His disordered thinking works itself out in bizarre ways of behaving: the hiding of papers, the hoarding of small samples of food, and secreting them in his cell. He seals and labels little parcels of food for testing, writing his name over them in all directions. Autism, stereotypies and manneristic be­haviour are noted from early on: he struts; he stands to attention; he stands and stares for a long time into the psychiatrist's eyes, before giving a convent­ional reply. He dresses in full uniform for his attempts at suicide or self­injury. His physiognomic appearance is noted more than once as typically schizophrenic. This is fully borne out by the excellent photographs in the book, which show a man completely shut away in himself, or suddenly and insanely laughing.